Nerve Entrapment of the Lower Extremity
Peroneal Nerve Entrapment is a common compressive neuropathy of the lower extremities. The Peroneal Nerve is a branch of the sciatic nerve, and supplies movement and sensation to the lower leg, foot, and toes. This condition can affect people of any age. Diagnosing the exact problem and receiving treatment early is critical to avoid irreversible nerve damage and injury progression.
Deep Peroneal Nerve (DPN) – Anterior Tarsal Tunnel Syndrome
Anterior Tarsal Tunnel Syndrome (ATTS) is the specific name for the condition where the DPN becomes entrapped between the extensor retinaculum on the top of the ankle and the navicular and talus bones beneath. The most common cause is trauma to the heel of the foot. Trauma can lead to the formation of fibrosis, compounding compression. Talonavicular osteophytosis, localized edema, high-heeled shoes, and ganglion cysts are other possible contributors to this syndrome.
Entrapment of the tibial nerve, or one of its branches, gives rise to Tarsal Tunnel Syndrome, which is the most common entrapment neuropathy in the foot and ankle area. This entrapment typically occurs within or distal to the tarsal canal, resulting in pain or sensory disturbance on the plantar aspect of the foot. Patients typically present with intractable heel pain. The term “tarsal tunnel syndrome” continues to be frequently used to define all entrapments of the tibial nerve or its branches, starting from posterior to the medial malleolus and extending distally.
Causes of Tarsal Tunnel injury:
- Trauma, such as ankle sprain or fractures
- Soft tissue or boney tumors
- Varicose veins
- Structural deformity, such as flat feet, causing pronation therefore pressing on the tibial nerve
- Venous insufficiency
- Systemic conditions such as Diabetes
Nerve Entrapment Warning Signs
Symptoms of nerve entrapment are indicated by pain, tingling and numbness, and foot drop, among other signs and symptoms. The condition can be overlooked, or misdiagnosed, so early intervention is necessary to avoid long-term or permanent nerve damage. That’s why we diagnose and treat lower extremity nerve entrapment at County Wide Foot, Ankle and Wound Care at our offices in Boynton Beach.
Nerve entrapment may occur due to compression of the Common Peroneal Nerve (CPN), Superficial Peroneal Nerve (SPN), Tibial nerve or Deep Peroneal Nerve (DPN), as indicated above. In many cases, patients displaying symptoms of nerve entrapment can make a full recovery if the condition is caught early and treated using conservative approaches and, if needed, minimally invasive treatments or surgery.
Lower extremity nerve entrapment causes:
- Trauma or knee injury (such as knee dislocation)
- Fracture of the fibula
- Long-term leg constriction
- Leg crossing or squatting
- Wearing high boots
- Chronic knee pressure
- Weight loss
- Scarring, lesions, or bone fragments
Symptoms of lower extremity nerve entrapment:
- Decreased sensation, numbness or tingling in the top of the foot or the outer part of the upper or lower leg
- Unable to hold foot up
- “Slapping” gait
- Toe dragging
- Weakness of the ankles or feet
- Loss of muscle mass
- Loss of muscle control in the lower legs and feet
- Atrophy of the foot or leg muscles
- Difficulty lifting the foot and toes for proper movement
Treating lower extremity nerve entrapment:
Determining the origin of the issue is paramount to being able to treat lower extremity nerve entrapment and regain full sensation. Understanding exactly which nerve is being constricted will also determine the course of treatment. Receiving treatment early is critical to avoid irreversible nerve damage and injury progression. An initial diagnostic check at County Wide Foot, Ankle and Wound Care in Boynton Beach will include checking the strength, sensation and gait of the foot and leg. Diagnostic testing includes:
- Observation of symptoms
- Nerve testing (to gauge symptoms and severity)
- Electrodiagnosic studies
- Xray imaging (especially for DPN)
- Nerve biopsy to rule out peripheral neuropathy
Initial treatment of lower extremity nerve entrapment calls for conservative approaches to alleviate symptoms, including physical therapy, adjusting to more appropriate footwear, non-invasive injections, and rehabilitation, especially for ankle instability.
Conservative Treatments Include:
- Braces, splints, or orthotics (shoe inserts)
- Physical therapy with anodyne therapy
- Medication to treat pain/inflammation (topical versus oral)
- Nerve vitamins containing alpha lipoic acid, Benfotiamine, vitamin B6 and B12
Minimally Invasive Treatments:
- Non-irritating injections of saline
- Local anesthesia
- Oral versus injectable steroids
- Amniotic injections to reduce adhesions and inflammation
- Surgery to alleviate pressure (decompression surgery)
- Excision of soft tissue mass or boney growth (if cause of nerve entrapment)
- Surgical correction of structural deformity (flatfoot reconstruction)
- Repair of ankle/foot fracture
If you’re concerned that you may be suffering with lower extremity nerve entrapment, contact our Boynton Beach, Florida office at 561-369-3300 and schedule a diagnostic consultation with Dr. Garzon, DPM, CWSP. Dr. Garzon has extensive experience with foot and ankle trauma, and reconstructive surgery where she serves as Chief Resident at Bethesda Hospital in Boynton Beach, Florida.